Healthcare Provider Details

I. General information

NPI: 1679807820
Provider Name (Legal Business Name): MOLLY M. MALOY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W 68TH ST
CHICAGO IL
60629-1813
US

IV. Provider business mailing address

2000 SPRING RD SUITE 200
OAK BROOK IL
60523-1804
US

V. Phone/Fax

Practice location:
  • Phone: 773-884-9000
  • Fax:
Mailing address:
  • Phone: 630-472-8800
  • Fax: 630-472-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: